ANNEX “F”

CERTIFICATION

This is to certify that the employees listed below are qualified for substituted filing of their pursuant to the
provisions of Section 2.83.4 of Revenue Regulations No. 2-98, as amended.

Name of Employee Taxpayer Identification Amount of Tax Due Withheld

Number Compensation and Remitted

I declare under the penalties of perjury, that this declaration has been made in good faith, and to the best
of my knowledge and belief to be true and correct.

Barangay Treasurer
Signature over Printed Name of Individual Income Payor/
Authorized Officer of Non-Individual Income Payor

SUBSCRIBED AND SWORN to before me this day of , 20 in ,

Applicant exhibited to me his/her issued at
on .

NOTARY PUBLIC
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